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For nearly a decade, pathology residency programs have used the Accreditation for Graduate Medical Education milestones with the intent to provide trainees with objective documentation on their progression through key [...], * Context.--Acquiring objective, timely, and comprehensive feedback on resident diagnostic performance is notoriously difficult. Objective.--To implement a custom software application (Resident Case Tracker) to improve evaluative diagnostic analysis for residency programs. Design.--Residents and faculty use a graphical user interface with restricted access to their own cases and evaluations. For each sign-out, residents enter their diagnoses and comments for each case. Faculty are provided a sign-out queue to review the resident diagnosis and select their level of agreement alongside optional comments. After sign-out, residents can review the agreement level and comments for each case, overall sign-out statistics, and organ-specific performance, and they have the option of opening and reviewing groups of cases by agreement status. A sign-out evaluation is automatically generated and stored alongside additional reports. Administrative access allows privileged users to readily review data analytics at both an individual and residency-wide global level. Results.--A marked increase in completed evaluations and feedback was noted in the initial 36 months of implementation. During a 3-year academic period, faculty completed individual feedback on 33 685 cases and 1073 overall sign-out evaluations. Conclusions.--Resident Case Tracker is an invaluable tool for our residency program and has provided unparalleled feedback and data analytics. Throughout residency, trainees have access to each completed sign-out, with the ability to learn from discrepant cases while also monitoring improvements in diagnostic acumen over time. Faculty are able to assess resident milestones much more effectively while more readily identifying residents who would benefit from targeted study.

In 2016, Black-Schaffer et al1 published recommendations on how the current pathology resident education model should transform in order to adapt to the changing medical landscape of the 21st century. [...], * Context.--A common concern in pathology residency training is the variability with which incoming trainees have attained basic pathology competencies during undergraduate medical education. While multifactorial deficiencies are likely due to recent de-emphasis of dedicated pathology courses during preclinical training, accelerating the transition from medical student to pathology resident is critical--particularly in military practice where a greater degree of autonomy is required of recent graduates. Objective.--To describe the implementation and results of a 4-week surgical pathology "boot camp" in the largest military pathology residency program in the United States. Design.--Interns were administered an assessment on basic pathology knowledge, slide practicals, and a skills self-assessment. All specimens were grossed by interns with constant direct supervision. A daily microscopic didactic session was given by an upper level resident and a daily gross conference was led by the interns. Subsequent academic performance was evaluated via monthly slide practicals and diagnostic agreement with faculty. Results.--Following boot camp, average scores on the knowledge assessment increased from 36.0% [+ or -] 16.2% (standard deviation [SD]) to 80.0% 6 12.6% (SD) (P < .001). Slide practical scores showed an increase from 32% [+ or -] 12.0% (SD) to 74.0% [+ or -] 16.2% (SD) (P < .001). Skills self-assessment showed a global increase across all measures. Throughout the following academic year, postgraduate year 1 (PGY1) residents performed at the same level of current PGY2 residents, based on surgical pathology faculty diagnostic agreement and slide practical performance. Conclusions.--An intense 4-week surgical pathology rotation specifically tailored to incoming interns was successful in transitioning medical students to pathology residents within a relatively short time. (Arch Pathol Lab Med. 2019;143:1144-1148; doi: 10.5858/arpa.2018-0318-EP)

The article presents a case study of a 47-year-old woman with combined variable immunodeficiency who developed a painful growing nodule on her right calf. The case study focuses on the diagnosis of Merkel Cell Carcinoma (MCC), discussing histopathological findings, immunohistochemistry, and relevant clinical considerations for distinguishing MCC from other similar tumors.

Historically, military anatomic pathology (AP) services have been significantly compartmentalized, with each branch independently executing its laboratory support mission. The result is redundant and costly duplication of nearly identical services in close geographic proximity. The duplication of AP services disperses the overall caseload, resulting in pathologist diagnostic acumen atrophy, excessive support personnel requirements, inadequate utilization of subspecialty expertise, and overall lower-quality patient care. Unlike many medical specialties, implementing AP services does not require direct patient interaction and is principally not as time-sensitive as other clinical laboratory testing. The practice of AP is conducive to a more consolidatory paradigm to achieve economies of scale. Pathology service unification would also afford the stationing of predominantly subspecialists at tertiary care centers to handle higher caseloads. Larger groups of pathologists increase patient safety enhancing peer-to-peer and subspeciality quality assurance processes during case review. Conversely, the nature of clinical pathology services requires a more widespread presence-even at the smaller, auxiliary clinics throughout the military health system. Clinical pathology services would also benefit from additional triservice cooperation including standardization of quality management processes, increased resource sharing, exchange, and cooperative contingency planning. Laboratory directorships also benefit from consolidating expertise, where pathologists could be physically located at a central site with remote oversight of laboratory services. Here, we propose a holistic triservice consolidation plan for military pathology to optimize resource utilization and ultimately realize the overarching strategic plan for military medicine set forth by the Defense Health Agency., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2025. This work is written by (a) US Government employee(s) and is in the public domain in the US.)